DEPARTMENT OF ENVIRONMENTAL PROTECTION
CHRIS CHRISTIE
MAIL CODE 401-02C
Division of Solid & Hazardous Waste
P.O. Box 420
Trenton, New Jersey 08625-0420
Telephone: (609) 292-9880 Telecopier: (609) 984-0565
http://www.state.nj.us/dep/dshw
Governor
KIM GUADAGNO
Lt. Governor
BOB MARTIN
Commissioner
TEMPORARY DEBRIS MANAGEMENT AREA (TDMA)
PRE-APPROVAL REQUEST FORM
For information on completing this form please see “Frequently Asked Questions on Pre-Approval of
TDMAs” and “Disaster Debris Planning Tool Kit for New Jersey Municipalities” or contact the Division of
Solid and Hazardous Waste at (609) 292-9880.
E-mail completed form with the required approvals to: [email protected] or fax the form to:
(609) 984-0565.
1. Applicant
Government Entity Requesting: ____________________________________________
Mailing Address: _________________________________________________________
City: _______________________________________ Zip Code:________________
Primary Contact:_____________________________ Title:______________________
Office #: _____-_____-______ ext. _____
Cell #: _____-_____-______
e-Mail:
Fax#: _____-_____-______
__________________________________
2. Location of TDMA (If debris management will be conducted at multiple
locations submit a separate form for each site):
Street/Intersection: _____________________________________________________
Municipality: _________________________
County: ______________________
Block # ______________ Lot # ________________
Is property owned by the entity requesting approval? ___ NO ___ YES
If no, name of property owner: ___________________________________
(Attach an agreement with the property owner for use of the property)
TDMA Pre-Approval Request Form
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New Jersey is an Equal Opportunity Employer l Printed on Recycled Paper and Recyclable
Last Revised 11/24/2014
Normal use of site: ___________________________________________________
Will multiple municipalities utilize the site? ___ NO ___ YES
If Yes, attach a shared service agreement and list municipalities:
_____________________________________________________________________
Is the location:
In a floodplain?
___ NO
___ YES
In wetlands or a wetlands transition area?
___ NO
___ YES
In a Pinelands Management Area?
___ NO
___ YES
In the Highlands Region?
___ NO ___ YES
If Yes, ___ Preservation Area or ___ Planning Area?
Describe security measures to prevent unauthorized access to the
site (i.e., fence, gate, police patrol, etc.):
________________________________________________________________________
Describe measures to control dust emissions (i.e., water truck,
hosing, paved road, truck tarping, etc.):
________________________________________________________________________
3.
Storage Area
Type of Debris to be Stored:
___ Construction & Demolition Debris
___ Bulky Solid Waste Debris
___ Household Hazardous Waste*
___ Putrescible Solid Waste*
___ e-Waste*
___ Vegetative Debris
___ Other: ______________________________
Description of Storage Area Surface:
___ Asphalt ___ Concrete ___ Grass ___ Gravel
Other: ______________
*I am advised and aware that Putrescible Solid Waste, White Goods,
Household Hazardous Waste (HHW), and e-waste storage areas must be
paved. _____ (Initial)
TDMA Pre-Approval Request Form
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Last Revised 11/24/2014
Will waste be stored in containers? ___ NO ___ YES
If Yes, which waste type(s): ________________________________________
Stockpile Dimensions and Volume:
(Vegetative stockpile size is limited to 250’ X 150’ X 25’)
Unprocessed Stockpile*:
Length: _______ feet
Width: _______ feet
Volume: _________ cubic yards
Height: ______ feet
Volume = ½ (Length X Width X Height) ÷ 27
Processed Stockpile (if applicable)*:
Length: _______ feet
Width: _______ feet
Volume: _________ cubic yards
Height: ______ feet
Volume = ½ (Length X Width X Height) ÷ 27
* Attach additional sheets for multiple stockpiles
4. Vegetative Processing*
Will processing be performed at this site?
___ NO
___ YES
If Yes, by what means:
___ Chipping
___ Grinding
___ Shredding
___ Other:________________
If Yes, will an outside contractor be retained to conduct the
processing? ___ NO ___YES
If Yes, provide name of contractor and attach contract or operating
agreement: ________________________________________________________
*I am hereby advised and aware that only vegetative debris may be
processed in a TDMA. _____ (Initials)
5. Attachments
A. Site Plan showing unprocessed and processed stockpile locations,
dimensions,
stormwater
controls
(including
distance
to
closest
stormwater inlet or surface water feature), site access, traffic
flow within site, and security measures.
NOTE:
The site plan does not have to be prepared by a
professional engineer.
TDMA Pre-Approval Request Form
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Last Revised 11/24/2014
B. Photographs of the site showing existing conditions.
NOTE:
Satellite photos are not sufficient as they may not show
current conditions.
C. Endorsements from the following agencies must be attached:
___ County Office of Emergency Management
___ Local Fire Official
Note: The Department will coordinate obtaining approvals from the
Stormwater Program, Green Acres Program, State Historic
Preservation Office, Endangered Species Program, Freshwater
Wetlands, Pinelands Commission (if applicable), and Highlands
Council (if applicable).
Additional information may be
requested.
Certification by Mayor, Public Works Supervisor, or local OEM of entity
requesting approval:
I certify under penalty of law that I have personally examined and am
familiar with the information submitted in this document and all
attachments and that, based on my inquiry of those individuals immediately
responsible for obtaining the information, I believe that the information
is true, accurate, and complete.
I am aware that there are significant
penalties for submitting false information and that submitting false
information may be grounds for termination of any approval granted.
I
further certify that I have read and fully agree to the terms listed in
the “New Jersey Department of Environmental Protection Disaster Debris
Management Tool Kit for New Jersey Municipalities”, that if I am storing
putrescible solid waste, household hazardous waste, white goods, or ewaste the area must be paved, and that non-vegetative debris will not be
processed.
Name (print) ____________________________________
Title (print) ___________________________________
Signature _______________________________________
TDMA Pre-Approval Request Form
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Date: ____/_____/_____
Last Revised 11/24/2014